fourth attempt
2 Replies
WDTP - September 29

Dear Dr Smith

You are remarkably generous individual to devote your time and expertise in this way. Congratulations to you for this wonderful generosity. I find I am often better informed through these forums than via my own Doctor.

My knowledge of the tech terms is ltd depite my attempts but from what I understand these are the facts!

I have been through three failed cycles, all on Gonal 150 (lucrin 15mg), ( I started on Gonal 250 but was reduced to 150 after a few days of my first cycle) aged 35 and originally no known cause from me or my partner although endo has been recently attributed as a possible related factor.

Cycle one was fresh with oestrogen levels of 12,000 and pick up on day 13. Nine occytes and seven fertilised. One transfer on day three, grade two four cell. The remainder were frozen but the second frozen cycle had poor thawing results, two were replaced but no luck. My third cycle was also a fresh cycle, oestrogen levels got to 14,000 by pick up on day 14 - there were fewer follicles than expected in ultrasounds so as I understand it my doctor was hoping to catch a few mature but not over sized. They got 8 follicles, varying in size from 18mmm to 28 mm. Five fertilized and they replace two, two grade two four cell. None were frozen as I asked htem to only freeze good quality and there were two grade three that survived. So fertilisation but a gradual degradation of embryo cell quality over time.

Subsequently I have had my first laparoscopy and removal of endo growth on both ovaries which wasn't properly discovered until post my third cycle (although the doc did refer to spotting some ovarian growth during my first cycle's ultrasound) I am now back on the gravy train with Gonal 150 and on day five my oestrogen level is 3300. AS per previous patterns I am expecting to climb to the 12000 mark by day 12.

Previous tests prior over the past few years suggested i ovulate well with good oestrogen levels but now I am wondering if my oestrogen levels are too high or if my egg quality is just not that great or am i just as unlucky as the many voices of this forum?

Can you have any advice for me, i am still v hopeful but perhaps that's naive?


Dr Smith - September 29

The estrogen levels you posted are in metric measure, so I had to actually use my brain and convert them to the American (antiquainted) system. They seem O.K.

The number of follicles and eggs also appears adequate.

What scares me is the endometriomas that were removed during the recent laparoscopy. Long standing endometriomas can effect the quality of the eggs in the immediate vicinity of the endometrioma. Although these eggs fertilize reasonably well, the resulting embryos do not develop well. Sound familiar? So, now your asking the question "If the endometriomas had been found earlier, would this have improved my chances?". The answer is probably not. Once an endometrioma begins to grow, before its detectable on ultrasound, it can affect the eggs in the surounding vicinity. So don't start second guessing.

Good news - endometriomas DO NOT affect all of the eggs, just the ones close by the endometrioma. So there are some good eggs in there somewhere. As always, I would suggest culturing the embryos to the blastocyst stage to identified the ones with the best developmental potential for transfer. Transferring one or two cell-stage embryos on Day 3 and freezing the rest is not working for you and its not provding any answers either. Not all clinics offer blastocyst transfer, so this may not be an option in your part of the world.


WDTP - September 30

This information is really helpful. I have been trying to figure out what might be going wrong with the poor embryo quality and your explanation re. how endometrioma can affect nearby eggs makes perfect sense. That in itself makes the process so much easier.

Thank you Dr Smith!



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